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U.S. Army-Baylor Univ. HCA Grad. Prgm. Research Committee

Technical Note Nr. 2 March 2003

The Readiness Estimate and Deployability Index (READI) Project

Development and use of a tool to prepare Army and Air Force nurses for deployment

U.S. Army-Baylor University Graduate Program in Health Care Administration

Purpose

Given the increase in the number and duration of deployment missions, Department of Defense (DoD) leadership needs to insure that military nurses are prepared to perform the skills and functions critical to their patient care role in a field environment. The studies conducted for this project resulted in a psychometric tool for nursing readiness assessment, the Readiness Estimate and Deployability Index (READI), which has been shown to be a valid and reliable measurement instrument. The READI is a 92-item survey questionnaire of self-reported competencies and behavior indicators based on six dimensions of readiness: clinical nursing competency, operational competency, survival skills, personal/psychological/physical readiness, leadership and administrative support, and group integration and identification.

Development and Application of the READI

Development

1997. Phase 1. Grant N96033 Tri-Service Nursing Research Program (Uniformed Services

Univ. Health Sciences): 30 highly experienced Army nursing personnel, 3 focus

group sessions over 8 months, identification and clarification of 6 core readiness

components: clinical nursing competency, operational competency, soldier survival

skills, personal/psychosocial/ physical readiness, leadership and administrative

support, and group integration and identification.

1999. Phase 2. Grant 600-06864000 Henry M. Jackson Foundation: Measurement

framework, items/scales construction, first draft of READI instrument.

Mar 1999 Pilot study: Colorado development sample n=31 Active duty and reserve Army

Nurse Corps (ANC) officers. Repeated measures, time1-time2, test-retest design,

n=62 observations. Test of ‘pilot format’ items, 6 sections, initial psychometric

evaluation, limited demographics.

Jun 1999 Focus group: instrument revised, items reworded, revised, re-scaled. New ‘field

format’ booklet and photocopy format version, 6 sections, 61 scaled attitude items,

31 behavioral items, total 92 items.

Application

Officer Advanced Course (OAC): active duty ANC officers, Captain/Major, world wide assignments, about a third with previous deployment experience

OAC Fall 1999 n=27, OAC Spring 2000 n=34, total n=61

Bosnia-Deployed: active duty, n=11 (incomplete, anecdotal)

Europe Installation: active duty, EUR Spring 2000 n=32

Officer Basic Course (OBC): recent ANC active duty officer Accessions, Lieutenant/Captain

OBC Winter 2000 n=118

Reserve Component OBC RSV Winter 2000 n=53

North Atlantic Region Medical Command: 188 active duty and 56 reserve officer nurses

NARMC 2001 n=244

Darnall Hospital, Ft. Hood, Texas: 97 Medcom and 50 Profis officer nurses

FT HOOD 2002 n=147

Data were also collected for LTC Dremsa’s doctoral dissertation at the University of Maryland, Baltimore. Air Force Nurse samples, 181 for inventory development, and 205 used for short form. READI-R-AFN 2000 n=386

Summary

To date, over 680 Army and over 380 Air Force Nurse Corps Officers (1000+) have participated in the READI research project. The READI has been shown to be a valid and reliable measure of perceived and self reported readiness among junior and mid-level DoD nurse corps personnel both on active duty and in reserve status. A sample of the U.S. Army READI instrument is at attachment 1.

READI Publications Presentations & Projects

Publications

Reineck, C., Connelly, L., Finstuen, K., & Murdock, P. (2001). Army Nurse Readiness Instrument: Psychometric evaluation and field administration. Military Medicine, 166(11), 931-939.

Kovats, K., Morris, M., Reineck, C., & Finstuen, K. (2001). U.S. Army Readiness: An active duty-reserve component comparison. Army Medical Department Journal, 01(7/8/9), 30-38.

Reineck, C. (1999). Individual Readiness in Nursing. Military Medicine, 164(4), 251-255.

Presentations

Reineck, C. (April, 1998). Individual Readiness in Nursing. Paper presented at the U. S. Forces Command Senior Field Nursing Conference, Atlanta, GA.

Reineck, C. (March, 1999). Nursing Readiness. Paper presented at the 9th Annual Asia- Pacific Military Medicine Conference, Bangkok, Thailand.

Finstuen, K., & Reineck, C. (11 Jun 1999). READI: Phase 2 psychometrics results. Presentation at the READI focus group conference, Tri-Service Nursing Program Research Grant, Officers Club, Ft. Sam Houston, TX.

Reineck, C. (May, 2000). Readiness Estimate and Deployability Index (READI). Poster presented at the 10th Annual Asia-Pacific Military Medicine Conference, Singapore.

Reineck, C., Connelly, L., Finstuen, K., & Murdock, P. (2000, November). The Readiness Estimate and Deployability Index (READI): A tool to prepare Army nurses for deployment. Proceedings of the 13th Karen A. Reider Nursing Research Poster Session, 107th Annual Meeting of the Association of Military Surgeons of the United States, Las Vegas, NV.

[Note: Authors individually presented Flag Letters of Appreciation by Rear Admiral K.L. Martin, Nurse Corps, U.S. Navy.]

Kovats, K. & Morris, M. (December, 2000). Application of the READI instrument to nurses in the AMEDD Officer Basic Course. Paper presented at the 14th Annual U.S. Army-Baylor University Health Care Administration Research Conference, U.S. Army Medical Department Center and School, Ft. Sam Houston, TX.

Kovats, K. & Morris, M. (February, 2001). Application of the Readiness Evaluation And Deployability Index instrument to nurses in the Army Medical Department Officer Basic Course. Paper presented at the Scholar’s Day and Luncheon, Graduate School, Baylor University, Waco, TX.

Kovats, K., Morris, M., Reineck, C., & Finstuen, K. (2001, April). U.S. Army Nursing Readiness: Active Duty vs. Reserve Components. Poster session presented at the U.S. Army Medical Command Military Treatment Facilities Senior Leadership Conference, San

Antonio, TX.

Reineck, C., Finstuen, K., Connelly, L., & Murdock, P. (2002, November). Perceived nursing readiness. Proceedings of the 12th Biennial Phyllis Verhonick Nursing Research Conference, San Antonio, TX.

Dremsa, T., Braun, R., Resnick, B., Derogatis, L., Turner, M., & McEntee, M. (2002, November). Readiness estimate and deployability index revised for Air Force nurses (READI-R-AFN) and READI-R-AFN short form(SF): Psychometric evaluation. Proceedings of the 12th Biennial Phyllis Verhonick Nursing Research Conference, San Antonio, TX.

Projects

U.S. Army – Baylor University Graduate Management Projects (GMP)

Murdock, P. (2001). U.S. Army nursing readiness: A field administration of the readiness estimate and deployability index (READI) in the North Atlantic regional medical command. U.S. Army-Baylor University Graduate Program in Health Care Administration. Alexandria, VA: Defense Technical Information Center, accession document.

Morris, M. (2002). A readiness evaluation of professional filler system and forces command nurses at Darnall Army Community Hospital, Fort Hood, Texas. U.S. Army-Baylor University Graduate Program in Health Care Administration. Alexandria, VA: Defense Technical Information Center, accession document.

University of Maryland Doctoral Dissertation

Dremsa (Collins), T. (2001). Readiness estimate and deployability index revised for Air Force nurses (READI-R-AFN) and READI-R-AFN short form(SF): Psychometric evaluation. PhD dissertation, University of Maryland, Baltimore.

Federal Grants

Reineck, C. (2000). Readiness instrument psychometric evaluation: Final Report. Tri-Service Nursing Research Program at the Uniformed Services University of the Health Sciences (Bethesda, MD) and The Henry M. Jackson Foundation for the Advancement of Military Medicine (Rockville, MD) for Grants MDA-905-98-Z-0027, N98058, and HMJF#600-06864000 (Program 119) .

Attachment 1 follows

READI instrument

(Army application version)

[pic]

INTRODUCTION

Purpose of the Survey

The purpose of the READY, are (1) to raise consciousness of the extent of preparation needed for Readiness and (2) to serve as a diagnostic tool for individuals or clinical nursing unit leaders.

Background

The Readiness Estimate and Deployability Index (READI) is a questionnaire designed to estimate the preparedness of Army Nursing personnel for worldwide deployment in support of Department of Defense missions. Questions on the READI are based on expert input from nursing personnel in active and reserve components, officer and enlisted, professional fillers, company grade and field grade nursing personnel in both TDA and TOE organizations worldwide.

Scoring

The READI is an index of readiness. It is not a comprehensive assessment. Rather, it will give an initial index or estimate of the basics of readiness. The READI is a self-assessment tool to measure the richer, human dimensions of individual readiness not otherwise reported. It measures self-report of individual readiness along six dimensions.

1. Clinical Nursing Competency

2. Operational Competency

3. Soldier/Survival Skills

4. Physical/Psychosocial/Personal Readiness

5. Leadership and Administrative Support

6. Group Integration and Identification

DIRECTIONS

Read each question and select the most appropriate answer (by checkmark, circle, etc.) as indicated on the READI questionnaire. NOTICE: Some questions ask you to selected more than one answer.

Thank you for your participation and support of readiness.

R.E.A.D.I.

Readiness Estimate and Deployability Index

Demographic Data

1. What is your current group? (check one) [ ] Active Component [ ] Army National Guard [ ] U.S. Army Reserve - Troop Program

Unit

[ ] Other ''

2. What is your area of concentration (AOC), if an officer, or military occupational specialty

(MOS) if enlisted? (check one)

[ ] 66C - Psychiatric Nurse [ ] 66H8F - Community Health Nurse

[ ] 66E - Perioperative Nurse [ ] 66H8G - OB-GYN Nurse

[ ] 66F - Nurse Anesthetist [ ] 66HM5 - Emergency Nurse

[ ] 66H00 - Medical Surgical Nurse [ ] 91B - Medical Specialist

[ ] 66H8A - Critical Care Nurse [ ] 91C - Licensed Practical Nurse

[ ] 66H8D - Nurse Midwife [ ] 91 D -Surgical Technician

[ ] 66H8E - Nurse Practitioner [ ] 91X - Behavioral Health Technician

3. How many years, military and civilian experience, do you have in the nursing AOC/MOS

you checked in question number 2 above? Years

4. To what major command are you assigned? (check one) [ ] USA Medical Command (Incl. Europe, Japan, and AMEDD C&S) [ ] USA Forces Command [ ] US Army Europe and Seventh Army (USAREUR) [ ] US Army Reserve (USAR) [ ] Army National Guard (ARNG) [ ] 8th US Army, Korea [ ] Other

5. If you are assigned to USA Medical Command, are you professional filler (PROFIS)? (Check one) [ ]Yes [ ] No [ ]Uncertain

6. What is your military rank?

[ ] 0 1 2nd Lieutenant [ ] E1-E3 Private, Private E-2, Private First Class

[ ] 02 1st Lieutenant [ ] E-4 Specialist

[ ] 03 Captain [ ] E-5 Sergeant

[ ] 04 Major [ ] E-6 Staff Sergeant

[ ] 05 Lieutenant Colonel [ ] E-7 Sergeant First Class

[ ] 06 Colonel [ ] E-8 Master Sergeant

[ ] E-9 Sergeant Major

7. Are you male or female?

[ ] Male [ ] Female

8. What is your ethnic background?

[ ] American Indian, Eskimo or Aleut [ ] Asian or Pacific Islander [ ] African

American

[ ] White [ ] Other

9. Are you of Hispanic/Spanish origin or ancestry? []Yes []No

10. To what type of unit are you assigned? (check one).

[ ] TO&E Unit. A tactical unit which may be deployed for combat.

[ ] TDA Unit

[ ] I do not know.

11. What is your deployment status? (check one)

[ ] I am currently deployed

[ ] I am not deployed but will be deployed within 90 days.

[ ] I am not deployed at this time and will not likely be deployed in the next 90 days.

12. Have you ever been deployed in your current AOC/MOS? [ ]Yes [ ]No

1

Section One

Clinical Nursing Competency

1. How familiar are you with the. different types of shock? (check one)

Not familiar [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ]5 Totally familiar

2. How competent are you in caring for patients in hemorrhage shock? (check one)

Not competent [ ] 1 [ ]2 [ ] 3 [ ] 4 [ ] 5 Totally competent

3. Consider this situation. You are deployed. You get to the scene of a MASCAL. There is ground ambulance support. There is one person who appears to have been hit in the leg. The patient is losing a steady stream of blood. The patient's vital signs are stable now. You placed a dressing over the wound, but you noticed you have to keep reinforcing it. The ambulance driver wants to know if the patient can wait till the next run to the treatment facility or if the patient has to go immediately. What is your assessment? (check one)

[ ] The patient can wait for the next ambulance. Patient is stable.

[ ] Patient has to go on the first ambulance. Increased potential for hypovolemic shock

4. Check the number that represents your competency with clinical documentation (use of SF 510,511) in a field environment.

Not competent [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 Totally competent

Emergency Nursing

1. When was the last time you provided direct patient care? (check one)

[ ] More than 4 years ago

[ ] Within the most recent 1-4 years

[ ] Within the last year, but more than 6 months ago

[ ] Within the last 6 months

2. What type(s) of triage experience and education have you had? (check all that apply)

[ ] I have not learned about triage yet

[ ] Learned through military or civilian courses (i.e. EFMB, OAC, Medical Management of Chemical Casualties Course etc..)

[ ] Learned through inservices, nursing courses, journals, handouts, etc..

[ ] Practiced triage in an ED setting

[ ] Practiced triage in a field environment on real and/or moulaged patients.

3. How competent are you to calculate an IV drip without your calculator or drug book? (check one)

Not competent [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 Totally competent

4. When was the last time you had to reconstitute medications, calculate dosages, and administer an IV medication? (check one)

[ ] More than 4 years ago

[ ] Within the most recent 1-4 years

[ ] Within the last year, but more than 6 months ago

[ ] Within the last 6 months

5. How competent are you to institute standing orders based on your ability to assess patients? For example, ordering X-rays, starting IV fluids, administering medications, etc.. without immediate contact with a physician? (check the number)

Not competent [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 Totally competent

6. How competent are you to perform in a code/emergency situation? (check one)

[ ] Not Competent (Would assist if someone told me exactly what and how to do it.)

[ ] Competent (Provided another nurse helped me, i.e. helped with drug calculations.)

[ ] Very Competent (Could provide nursing care requirements without supervision or with minimal assistance.)

2

7. Do you understand the concept of body surface area in relation to a burn patient and are you competent in calculating it? (check one)

[ ] No, Don't know what it is nor how to calculate it.

[ ] Heard of it before, but not able to calculate it.

[ ] Know a little about it and may be able to calculate it.

[ ] Understand it and probably could calculate it.

[ ] Understand it and can calculate it.

8. How competent are you when deciding which critically ill or injured patients get seen first? (check one)

Not competent [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 Totally competent

9. Consider a situation if a doctor is not present. How competent are you in performing ACLS protocols? (check one)

Not competent [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 Totally competent

10. How competent are you taking care of life threatening injuries? (check one)

Not competent [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 Totally competent

11. Are you competent in your IV skills? [ ]Yes [ ]No

12. Could you in some detail describe the life-saving ABC principles? [ ]Yes [ ]No

13. Do you feel competent to assess a multiple trauma patient? [ ] Yes [ ] No

Check the number that indicates your level of competence on each of the patient situations

listed below.

14. Care of patient with NBC injuries

Not competent at all [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 Totally competent

15. Ballistic missile injuries

Not competent at all [ ] I [ ] 2 [ ] 3 [ ] 4 [ ] 5 Totally competent

16. Recognition of tension pneumothorax

Not competent at all [ ] I [ ]2 [ ] 3 [ ] 4 [ ] 5 Totally competent

17. Fluid resuscitation of a burn patient

Not competent at all [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 Totally competent

18. Universal blood donor protocol

Not competent at all [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 Totally competent

19. Disease, non-battle injuries

Not competent at all [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 Totally competent

20. Use of field ventilator

Not competent at all [ ] I [ ] 2 [ ] 3 [ ] 4 [ ] 5 Totally competent

3

21. Airway management

Not competent at all [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 Totally competent

22. Implementing triage categories

Not competent at all [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 Totally competent

23. Clinical team leadership

Not competent at all [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 Totally competent

24. Caring for refugees

Not competent at all [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 Totally competent

25. Antepartum/postpartum care

Not competent at all [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 Totally competent

26. Field infection control

Not competent at all [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 Totally competent

27. Orthopedic nursing

Not competent at all [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 Totally competent

28. Neurologic nursing

Not competent at all [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 Totally competent

Physical Assessment

Please rate according to Level of Present Knowledge/Skill (check the number)

1. Identify the components of a physical examination

Low [ ] 1 [ ]2 [ ]3 [ ]4 [ ]5 High

2. List the five examination techniques to perform a physical examination

Low [ ] 1 [ ]2 [ ]3 [ ]4 [ ]5 High

3. Perform a complete nursing assessment and interpret abnormal findings

Low [ ]1 [ ]2 [ ]3 [ ]4 [ ]5 High

4

Section Two

Operational Nursing Competency

Consider this situation. The 4 limb electrodes of a cardiac monitor-recorder are attached to a patient and you have just obtained an EKG tracing in the field. You have been asked to obtain a 12 lead EKG on the patient. You have the following equipment and supplies: Field table; cardiac monitor; 4 metal limb electrodes attached to patient with holding straps; 1 suction cup electrode; 1 tube of electrode gel; 1 roll of recording paper; 1 box of alcohol pads; 1 patient on a hospital bed.

1. How competent are you to obtain a 12-lead EKG using the appropriate procedure and equipment describes above? (check one)

Not competent at all [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 Totally competent

Consider this situation. You are providing patient care in a field environment and need to suction oropharyngeal secretions from a patient. You have the following equipment and supplies: Field table; 1 portable oropharyngeal suction apparatus; sterile patient suction tubing and suction catheter; 1 small container of water; 1 pair of clean gloves.

2. How long can the suction apparatus operate on internal battery pack? (check one)

[ ] 2 hours [ ] 1 hour [ ] 45 minutes [ ] 30 minutes [ ] 20 minutes

3. How many hours does it take for the internal battery pack to recharge when completely

discharged? (check one)

[ ] 8 hours [ ] 16 hours [ ] 20 hours [ ] 24 hours [ ] 30 hours

4. In the field medical treatment facility or ward, the mode of electrical operation for the suction apparatus is AC power source [ ] True [ ] False

5. In the ambulance or other evacuation vehicle, the mode of electrical operation for the suction apparatus is a DC power source [ ] True [ ] False

6. For a patient on a litter, the mode of electrical power for the suction apparatus is a DC power source. [ ] True [ ] False

Check the number that indicates your level of competence in these operational areas:

7. Evacuation Procedures .

Not competent at all [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 Totally competent

8. Echelon of Care

Not competent at all [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 Totally competent

9. Reporting an unlawful act or conduct

Not competent at all [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 Totally competent

10. Field sanitation and hygiene

Not competent at all [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 Totally competent

11. DEPMEDS Setup

Not competent at all [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 Totally competent

5

Section Three

Soldier and Survival Skills

1. Check the number that best represents how familiar you are with the M-16 rifle.

Not familiar [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 Totally familiar

2. Check the number that represents how familiar you are with the 9mm pistol

Not familiar [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 Totally familiar

3. How competent are you in your ability to defend yourself and/or your patient(s) if called upon to do so? (check the number)

Not competent [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 Totally competent

4. 1 am competent and confident in y ability to protect myself and my patients using the M40 mask and MOPP gear. (check 1e number)

Strongly disagree [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 Strongly agree

5. How competent are you in your ability to navigate using a map and compass? (check the number)

Not competent [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 Totally competent

6. How competent are you in your ability to maintain your individual weapon in working order? (check the number)

Not competent [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 Totally competent

7. How competent are you in your ability to perform your primary military specialty under adverse and/or prolonged field conditions? (check the number)

Not competent [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 Totally competent

8. How competent are you in your ability to decontaminate yourself and your patients(s) using standard Army decontamination equipment? (check the number)

Not competent [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 Totally competent

9. Check the number that represents how familiar you are with your status under the Geneva Conventions should you be captured by enemy forces.

Not competent [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 Totally competent

10. If you were captured, how competent are you in your ability to resist the enemy? (Check the number)

Not competent [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 Totally competent

11. Check the number that represents your familiarity with standard Army communications equipment. (i.e. field radio)

Not familiar [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 Totally familiar

6

Section Four - A

Personal and Physical Readiness

1. Check the box that most closely represents your last APFT score.

[ ] 24 mos, [ ] 19-24 mos. [ ] 13-18 mos. [ ] 6 12 mos.[ ] 14 days

3. How familiar are you with your deployment unit's mission, vision, and values? (check one)

[ ] Very Familiar [ ] Familiar [ ] Neither/Nor [ ] Somewhat Familiar [ ] Not Familiar at All

4. How familiar are you with your role/duty assignment within your deployment unit? (check one)

[ ] Very Familiar [ ] Familiar [ ] Neither/Nor [ ] Somewhat Familiar [ ] Not Familiar at All

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